Background <p>This study evaluated the long-term structural, functional, and microvascular outcomes in school-aged children with a history of laser photocoagulation (LP) therapy for the treatment of type 1 retinopathy of prematurity (ROP). The macular integrity, retinal sensitivity, fixation stability, and microvascular parameters were assessed using microperimetry and optical coherence tomography angiography (OCT-A).</p> Methods <p>This retrospective cross-sectional study included children aged 10–15 who underwent detailed ophthalmologic examinations. Participants were divided into three groups: (1) children who had received LP for the treatment of ROP in infancy, (2) prematurely born infants without any ROP diagnosis, and (3) full-term controls. Statistical analysis was conducted to compare fixation stability, foveal avascular zone (FAZ) area, and vascular density (VD).</p> Results <p>A significant difference was found in fixation stability among the groups, demonstrating more stable fixation in term-born children compared to preterm groups and significantly eccentric fixation in laser-treated infants (<i>p</i> = 0.019 and <i>p</i> &lt; 0.001, respectively). Furthermore, FAZ areas were substantially smaller, and VD values were higher in laser-treated infants (<i>p</i> &lt; 0.001 for both). A negative correlation was identified between fixation instability and FAZ size (<i>p</i> = 0.016 and <i>p</i> = 0.015), suggesting a relationship between fixation behaviour and foveal microvascular integrity.</p> Conclusion <p>The diagnosis and treatment of ROP can significantly affect long-term visual functions, fixation behaviours, and macular vascular development. These findings emphasise the importance of long-term follow-up for preterm infants and the need for further studies to investigate the relationship between fixation stability and retinal microvasculature.</p>